This article analyzes the extent to which international public
health has become securitized and what effects this has on global health
governance and the biological weapons control regime. Attempts to
securitize public health are traced in the two multilateral discursive
spaces of greatest relevance to biological weapons arms control and
international public health; the community of state parties to the
Biological Weapons Convention, and the World Health Organization. The
conclusion is that with respect to public health, the identified
securitization moves have led to a strengthening of the state as actor
in the provision of international public health. For biological weapons
arms control, the impact of the identified securitization moves depends
largely on the overall development of the biological weapons control
regime. KEYWORDS: securitization, international public health, health
security, biological security, biological weapons.

**********

Public health and biological weapons arms control would appear to
be two distinct policy arenas with little, if any, overlap in terms of
actors involved, problems to address, and solutions to be proposed to
better the human condition. Traditionally, security from biological
weapons and security from disease were pursued by different actors on
both the domestic and the international level. For the former,
biodefense and biological weapons (BW) arms control policies were
formulated by the military and diplomatic communities, while
responsibility for disease prevention and mitigation fell to the public
health sectors of states, or to international organizations such as the
World Health Organization (WHO). This strict separation has become
increasingly blurred.

Starting in the mid-1990s, the possibility of terrorism with
biological and chemical weapons has evolved into the number one security
threat for military planners and decisionmakers in many countries, most
notably the United States. This dramatic shift in threat perception,
which was fueled first and foremost by the Aum Shinrikyo 1995 sarin gas
attack in the Tokyo subway system and the 2001 anthrax letters sent
through the US postal service, had two effects that so far have not been
thoroughly analyzed. First, it shifted the balance between biodefense
and BW arms control in the fight against biological warfare toward
biodefense. The process of readjusting this equilibrium in favor of
biodefense has brought with it the second effect: the drafting of public
health to fight bioterrorism. (1) While biodefense activities had in the
past been geared toward hostile states employing BW, and thus had
focused on troop protection in the field by the military forces
themselves, this approach was no longer deemed valid in the age of
global bioterrorist threats. Those who are "at risk from biological
warfare" are no longer a subsection of the population--the armed
forces--but are now the population as a whole. Consequently, protective
measures had to extend to whole populations as well: enter the public
health infrastructure. To better capture and analyze the processes
related to this "drafting" of the public health sector, or
parts thereof, the concept of "securitization" will be
applied. As I have argued elsewhere, such securitization moves have been
successfully employed in the United States over the past decade. (2)

The term securitization was introduced into the security studies
discourse during the 1990s by a group of scholars, including Ole Waever
and Barry Buzan. (3) The development of the concept has to be seen in
the context of a more general trend to move beyond a focus on the
nation-state and on the provision or analysis of military security
issues only. (4) To overcome the shortcomings of some competing
approaches to broadening the concept of security, Waever and his
colleagues proposed to concentrate on the specificity of security
studies and reformulate the concept of security on that basis. Two
operations are crucial in this context: speech acts (uttering security)
and modalities (threat-defense sequences). (5) The process of
securitization is initiated through a

speech act where a securitizing actor designates a threat to a
specified referent object and declares an existential threat implying
a right to use extraordinary means to fence it off. The issue is
securitized--becomes a security issue, a part of what is security--if
the relevant audience accepts this claim and thus grants the actor a
right to violate rules that otherwise would bind. (6)

If a securitizing speech act is performed successfully--and, as I
show in this article, this is by no means always the case--the
threat-defense sequence, which has characterized traditional thinking
about security, has been successfully put into action for a new issue,
one that was previously separate from the security discourse.

There are thus three elements to the securitization process: a
securitizing actor, a referent object to be securitized, and an audience
that accepts (or rejects) the securitizing move. Thus, by looking at
speech acts, the securitization concept allows an observer to analyze
and link discursive interventions and policy measures beyond those that
would normally be considered appropriate. Usually, such new policy
measures would manifest themselves in shifting budgetary priorities.

In applying this framework, I analyze the extent to which threats
to public health through the deliberate spread of disease have become
securitized. As mentioned above, the emergence of the bioterrorist
threat in the mid- to late 1990s has in the United States coincided with
a reduced reliance on BW arms control in addressing the specter of
biological warfare. Instead, biodefense measures, with the concomitant
securitization of public health, have been placed center stage in the
effort to counter the newly identified existential threat of
bioterrorism.

In order to trace securitization moves and map the resulting
changes in international public health discourse and the implications
this has for both the globalization of public health and the
international regime to prohibit BW, I provide in the next section an
overview of the deliberate spread of disease in the form of biological
warfare. In the following two sections I briefly describe the tools to
fight both deliberate and natural disease; BW arms control; and
international public health prior to the emergence of bioterrorism as a
new existential security threat. My focus in the subsequent section is
on the emergence of bioterrorism as security threat and the
securitization moves in relation to public health on the international
level, with emphasis on the two discursive spaces of the WHO and the
community of Biological and Toxin Weapons Convention (BWC) member
states. I conclude with a discussion of the implications for the global
governance of public health and BW arms control that result from the
identified public health securitization moves.

Biological Warfare as "Deliberate Disease"

The use of disease-causing biological agents, or pathogens, in
warfare goes back at least several hundred years. (7) Biological warfare
agents are usually grouped into five categories: (1) bacteria, such as
Bacillus anthracis, the causative agent of anthrax; (2) viruses, such as
the ones that cause smallpox, or Ebola; (3) rickettsiae, such as the
organism that causes Q-fever; (4) fungi, such as the Aspergillus fungi;
and (5) toxins--nonliving products from microorganisms, plants, or
animals--such as botulinum toxin, or ricin. Some of these BW agents are
mostly incapacitating, while others have a high lethality. Also, some BW
agents will be localized in their effects, while others--due to their
contagiousness--may cause widespread epidemics. Following from this
diversity, biological warfare agents can be employed in a number of
attack scenarios. (8)

To make efforts to implement the prohibitory norm against
biological warfare even more challenging, the material, technologies,
and know-how needed for offensive military BW programs or the pursuit of
terrorist BW attacks are of a so-called dual-use character. Not only can
they be used for offensive military purposes, but many of the
"ingredients" of a BW program have perfectly legitimate
civilian applications. Thus, it cannot be deduced from the mere presence
of a seed culture of a particular pathogen or a specific type of
equipment that a state pursues an offensive BW program.

Furthermore, the nature and scope of biological warfare has changed
dramatically as a result of the revolution in the life sciences. As
Malcolm Dando has shown for the "three generations of offensive
biological warfare programs" of the twentieth century, all the
military programs were "developing on the back of growth in
scientific knowledge." (9) This pattern seems to continue. As a
panel of life sciences experts concluded in a recent assessment of the
threat of advanced BW based on biotechnological methods and processes
that was conducted for the CIA,

Classes of unconventional pathogens that may arise in the next decade
and beyond include binary BW agents that only become effective when
two components are combined ...; "designer" BW agents created to be
antibiotic resistant or to evade an immune response; weaponized gene
therapy vectors that effect permanent change in the victim's genetic
make up; or a "stealth" virus, which could lie dormant inside the
victim for an extended period before being triggered. (10)

Thus, problems in fighting the naturally occurring disease agents
of today might be dwarfed by the genetically modified agents of the
future, putting an ever increasing burden on biodefense and public
health systems.

Fighting Deliberate Disease Through Biological Weapons Arms Control

The Structure of the BW Prohibition Regime

The BW prohibition regime rests largely on the 1972 Biological and
Toxin Weapons Convention. It is based on the recognition that the use of
BW agents constitutes an abhorrent act of warfare and is therefore
prohibited. At the same time, peaceful uses of the biosciences are
regarded as a legitimate undertaking. According to BWC Article I,

Each State Party to this Convention undertakes never in any
circumstances to develop, produce, stockpile or otherwise acquire or
retain:
(1) Microbial or other biological agents, or toxins whatever their
origin or method of production, of types and in quantities that have
no justification for prophylactic, protective or other peaceful
purposes. (Emphasis added) (11)

This so-called general purpose criterion makes it clear that not
only are peaceful uses of the biosciences legitimate undertakings for
states parties to the BWC, but so are defenses against the threat or use
of BW. This principle is rooted in the belief that the peaceful uses of
biosciences cannot be taken for granted--be it for the lack of
universality in membership or for a state party not living up to the
obligations it has assumed.

Central to the normative guidelines for state action contained in
the BW control regime is the non-use norm. It is explicitly spelled out
in the 1925 Geneva Protocol and implicitly contained in Article I of the
BWC. (12) Of particular relevance to the interrelation between
biodefense and public health, and the securitization of the latter, are
three further regime norms: the cooperation norm contained in Article X
of the BWC; the assistance norm as spelled out in BWC Article VII,
according to which state parties will come to each other's
assistance in case of the use or threat of BW against one of them; and
the internalization norm, as stipulated in Article IV of the BWC.
According to the latter norm, state parties have to internalize the
prohibitions of the BWC and prevent the activities banned under the BWC
from taking place on their territory. Yet, how this is to be
accomplished is left to the interpretation of state parties.

Efforts to Strengthen the BW Prohibition Regime

The two central weaknesses of the BW control regime--the absence of
a verification principle and the lack of precise rules and procedures
that would specify how to implement the norms of the regime in everyday
state practice--came to the fore soon after entry into force of the BWC
in 1975. The confidence-building measures (CBMs) agreed upon during the
Second and Third BWC Review Conferences in 1986 and 1991 represent one
attempt to remedy these shortcomings. However, as one review of the data
submissions up to 2003 has revealed, implementation of the CBMs was
poor. (13)

In parallel to these CBMs, a process was initiated that initially
looked into the technical feasibility of potential verification measures
for the BWC (during 1992-1993) and led to negotiations on a verification
protocol, which lasted from 1995 to 2001. Yet, already the formulation
of the negotiating mandate proved contentious and allowed for various
diverging goals to be pursued in the negotiations. (14) To speed up
negotiations, Ambassador Tibor Toth, chair of the Ad Hoc Group (AHG),
developed a compromise text, which he presented to delegations in spring
2001. (15) The July 2001 session of the AHG was scheduled to discuss
this compromise text. While there was considerable support for the
approach taken by Ambassador Toth, the United States concluded that the
overall approach taken in the negotiations up to that point was flawed
and the draft protocol text would reduce and not increase security
against BW.

The ensuing sense of failure was compounded during the last day of
the Fifth BWC Review Conference when the United States came forward with
a proposal to terminate the AHG for good. The content of this proposal
ran counter to the tacit understanding not to touch the topic of the AHG
in order to avoid a breakdown of the review process as well. Moreover,
the United States did not inform any of its allies in advance about the
content or timing of the proposal. Not surprisingly, this created the
impression that the US delegation was deliberately attempting to wreck
the conference. The only way to prevent a diplomatic disaster was to
adjourn the conference and reconvene one year later, in November 2002.
(16) During this second part of the conference, a set of five measures
was agreed on to guide discussions among state parties for the years
2003-2005. One of the measures was international cooperation in the
fight against infectious disease.

Public Health in the Fight Against Natural Diseases

The International Public Health Regime

Although international cooperation to improve public health started
in the middle of the nineteenth century, it was the establishment of the
WHO in 1948 that marked the birth of today's international public
health regime. (17) When the WHO was set up, its members agreed on the
principles that "the enjoyment of the highest attainable standard
of health is one of the fundamental rights of every human being"
and that the "health of all peoples is fundamental to the
attainment of peace and security and is dependent upon the fullest
cooperation of individuals and States." (18) Despite this lofty
rhetoric, including peace and security, Anne-Marie Slaughter reminds us
that the WHO falls in the category of more specialized international
organizations that "address less overtly 'political'
subject areas than international and regional security." (19)

During the first three decades of its existence, the WHO attempted
to implement its mandate largely through a disease-oriented policy. This
rather technical approach found its expression in the adoption of the
International Health Regulations (IHR). In it, WHO member states agreed
to two normative guideposts for their public health policy. First, they
agreed to notify the WHO of outbreaks of diseases covered by the IHR.
Initially six diseases were subject to this notification norm: smallpox,
typhus, relapsing fever, cholera, malaria, and yellow fever. After a
1981 modification of the IHR, only the latter three had to be reported to the WHO. The primary goal of the IHR "is to ensure the maximum
security against the international spread of diseases with minimum
interference with world traffic," (20) In addition, the IHR was
designed to interfere only marginally with how WHO member states
organized their domestic health policies. Rather, its primary target has
been to prevent the transborder movement of disease-causing organisms.
Only a limited set of requirements--this represented the second, much
weaker, normative guidepost of the IHR--has been imposed by the IHR on
states to undertake certain public health measures at ports and
airports. However, as David Fidler summarizes, the "IHR failed
massively to achieve their objective." (21) This failure was first
and foremost due to the widespread noncompliance of member states with
the reporting requirements under the IHR. Second, the large number of
newly emerging or reemerging infectious diseases, especially HIV/AIDS,
demonstrated the growing irrelevance of the reduced list of diseases
that were to be reported. The World Health Assembly (WHA), the
WHO's highest governing body, acknowledged this failure in 1995 and
tasked the WHO with revising the IHR. (22) In 2001, WHA Resolution 54.14
"supported the ongoing revision, including criteria to define what
constitutes a public health emergency of international concern."
(23) Based on the work of an intergovernmental working group, the new
regulations were adopted by the WHA in May 2005. (24)

From International to Global Public Health?

Programs to eradicate specific diseases have been departing from
this interstate focus of WHO activities and have attempted to interfere
much more deeply with capacity-building efforts in member states and the
organization of their public health systems. The programs to eradicate
smallpox and malaria are two examples of success and failure,
respectively, of such programs. (25) A more general shift away from the
horizontal strategies based on intergovernmental relations, as embodied
in the IHR, was signaled by the "Health for All" declaration
agreed on in 1978 in Alma Ata. As Fidler points out with respect to this
shift in priorities, "The need of the great powers for the kind of
international cooperation embodied in the IHR had all but vanished,
leaving the regime without its traditional political engine." (26)
This opened the discursive space for addressing and reaffirming health
as a fundamental human right, whose realization cannot be limited to the
monitoring and reporting of three communicable diseases. The linkage
between health and human rights was further strengthened when the WHO
integrated efforts to stop the discrimination of those affected by
HIV/AIDS into its policies to address the disease. This clearly
represented a further step in eroding the sovereignty of states to deal
with a crucial public health issue on their own terms. (27) Calls to
that end also came from the international development arena, where in
the early to mid-1990s the annual reports of the United Nations
Development Programme (UNDP) started to focus on human security, with
health security being one of its core dimensions. (28)

Intergovernmental public health policies came under additional
pressure from a number of globalization-related processes. As Richard
Dodgson and Kelley Lee point out, "Globalisation has introduced or
intensified trans-border health risks," which include
"emerging and re-emerging infectious diseases, various
non-communicable diseases ... and environmental change," (29) In
particular, the issue of emerging and reemerging diseases has occupied a
large part of public health discourse since the early 1990s, both
nationally and internationally. (30) This discourse increasingly
involves a multitude of nonstate actors in the form of both
health-oriented NGOs and multinational corporations. (31) In general
terms, globalization has reduced state capacity to adequately address
problems in a variety of issue areas--public health among them.

Acknowledging this decreased state capacity, nonstate actors have
been brought into the international public health arena as information
providers. This has begun to redirect the discourses and processes of
international public health away from a purely state-centric approach.
Fidler aptly illustrates this trend with the example of NGO-generated
disease surveillance data that are now being utilized by the WHO and fed
into its Global Outbreak Alert and Response Network (GOARN). The need to
harness this additional source of information was identified early in
the process of revising the IHR, but the process for formalizing the use
of data from nonstate actors then took on a life of its own. The use of
nongovernmental disease surveillance data, started in 1997, was approved
by the WHA in 2001 and thus preceded the conclusion of the IHR revision
in 2005 by several years. (32)

The Emergence of Bioterrorism and the Securitization of Public
Health

Following the actual emergence of the use of biological agents by
criminals or terrorists, an academic discourse on bioterrorism began to
form during the 1970s. (33) For the 1970s, Seth Carus reports eight
cases of bioagent use, nine for the 1980s. Figures for bioagent
incidents skyrocketed during the 1990s, with much of the increase
occurring during the second half of the decade. He identifies 153 cases
for the 1990s, which brings the total to 180. However, many of these
"cases" took place only in the mind of perpetrators or were
hoaxes: Carus puts 137 out of the 180 reported cases in the latter
category. (34) A group of US scholars investigated twelve of the most
plausible cases, but even of these, three turned out to be apocryphal.
(35)

The shift in academic and political discourse that sought to
establish whether the new fear of bioterrorism was supported by facts or
was "hyped" (36) was triggered by the Aum Shinrikyo attack in
March 1995. This attack, in which the nerve agent sarin was released in
commuter trains of the Tokyo subway system, killed twelve people and
injured several hundred more. (37) Beginning in the mid-1990s, that
attack--in conjunction with the Oklahoma City bombing--led to calls in
the United States for expanded measures to counter potential
bioterrorist attacks, including the utilization of the public health
system. However, hardly any corresponding efforts to securitize public
health were visible at the international level before the fall of 2001.

After the World Trade Center and Pentagon attacks in the United
States on September 11, 2001, and the subsequent anthrax letters sent
through the US mail, attempts to securitize public health manifested
themselves on a number of levels and led to a variety of institutional
responses, such as the G8 global health security initiative, and
different policy measures at the European Union level. However, the
focus here is on the two discursive spaces with the clearest mandate on
the international level to address public health and the biological
weapons threat--that is, the World Health Organization and the meetings
of state parties to the BWC.

The WHO and the Securitization of International Public Health

In spring 2002, in the aftermath of the anthrax attacks in the
United States, the WHO secretariat, in preparation for the Fifty-fifth
World Health Assembly (WHA), produced a report entitled "Deliberate
Use of Biological and Chemical Agents to Cause Harm." (38) The
report points out that in response to such an incident, the organization
is to "strengthen public health disease alert systems at all
levels, as such a system will detect and respond to diseases that may be
deliberately caused." (39) In case the United Nations were tasked
to investigate a disease outbreak, the report suggested that the

WHO could be asked to provide technical expertise or to make available
its existing resources and mechanisms. Non-public health issues
related to investigations of reports on possible use of chemical and
bacteriological (biological) or toxin weapons, however, remain the
responsibility of the United Nations. If such a request were made,
information about the public health response, including the results of
epidemiological and laboratory investigations, would be reported by
WHO to the government of the country or countries where the event was
occurring. (40)

With this statement, the WHO clearly rejects any attempts at
international public health being securitized and positions itself
outside the BW arms control context. An expansion of the WHO mandate to
function as a substitute verification organization for the BWC is
rejected.

In the WHA resolution based on this report, member states are urged
to adopt national measures regarding disease surveillance, to
collaborate in capacity building, and to assist one another in case of a
deliberately caused epidemic. These national measures are to be
supported by the WHO secretariat through the strengthening of global
surveillance mechanisms for infectious disease, the provision of tools
and support for member states, and international guidance and technical
information that would support public health systems in countering
deliberate epidemics. (41)

The Department of Communicable Disease Surveillance and Response in
the WHO secretariat had already set up its Programme for the
Preparedness for Deliberate Epidemics (PDE) in response to the anthrax
attacks in the United States. Following the WHA resolution, PDE was
developed into three main areas: (42)

* International coordination and collaboration. This involves the
contribution of WHO staff to a variety of meetings organized in the
context of the BWC, the North Atlantic Treaty Organization, or the Red
Cross.

* National capacity strengthening on preparedness for and response
to the deliberate use of bioagents. In this area, the WHO issued
recommendations on the development of guidelines, expert networks, and
training. One concrete example is Guidelines for Assessing National
Health Preparedness Programmes for the Deliberate Use of Biological and
Chemical Agents.

* Public health preparedness for diseases associated with the
deliberate use of biological agents. In this context, "WHO is
strengthening selected disease-specific networks, starting with anthrax.
Other priority diseases--identified by a WHO risk assessment--include
plague, tularemia, brucellosis, glanders, melioidosis, Q fever, typhus
fever ... and smallpox." (43)

All the activities conducted under PDE are being funded by
extrabudgetary resources, which are donated by member states with an
interest in these issues. The original program budget for the biennium
2002-2003 was below US$1 million, (44) and although this has increased
for the period 2004-2005, it still funds only a small team dedicated to
preparedness for deliberate diseases.

In parallel to these limited PDE activities, the discourse on the
revision of the IHR gained momentum. (45) Following consultations with
state parties, the WHO secretariat circulated a first draft of the
revised IHR in early 2004. (46) Extensive regional consultations were
followed by three rounds of negotiations, which took place in Geneva between November 2004 and May 2005. Already the first draft IHR
contained four major new elements that expanded the scope of the IHR
considerably. State parties would now be required to "notify all
events potentially constituting a public health emergency of
international concern"; set up a national IHR focal point; and
implement "the minimum core surveillance and response capacities
required at the national level in order to successfully implement the
global health security, epidemic alert and response strategy." In
addition, the revised IHR were conceptualized as the legal framework for
that strategy. (47) Although a large part of the discourse on IHR
revision was characterised by a consensus on the need to expand the
scope of the regulations, just how far such an expansion should go was
contested among WHO states parties. Diverging views came to the fore in
particular with respect to the question of IHR coverage of chemical,
biological, radiological, and nuclear (CBRN) weapons incidents. While
some state parties--among them the United States--believed that the IHR
could also be utilized to gather information not otherwise obtainable on
such incidents, state parties from the developing world, most notably
from the Southeast Asian and eastern Mediterranean regional groups, were
led in their rejection by Pakistani and Iranian delegates. (48) The
evolution of the discourse on notification criteria contained in Annex 2
to the revised IHR is particularly instructive in this regard: the
language provided by an Ad Hoc Expert Group report in February 2005
cited the "release into the environment of a chemical or
radionuclear agent that has contaminated or has the potential to
contaminate a population and/or a large geographical area" (49) as
one of the criteria prompting notification to the WHO. In the final
version of the IHR, all references to chemical or radionuclear agents
have been eliminated, because some delegations argued that their
explicit mention would place too much emphasis on CBW scenarios and thus
risk going beyond WHO's mandate. (50) Instead, Annex 2 now lists
the "spread of toxic, infectious or otherwise hazardous material
that may be occurring naturally or otherwise" as one of the
criteria for notification. (51) In combination with references to
"unexpected and unusual outbreaks of disease" in Annex 2 and
in the main body of the text, this wording was able to bridge the divide
between those advocating a further-reaching securitization of the
revised IHR, including the United States, and those mostly concerned
with limiting the degree of transparency that has to be provided under
the IHR to information that is "commensurate with and restricted to
public health risks," (52) such as Pakistan. Concerning the role
played by the WHO bureaucracy in developing this discourse, all
interviewed delegates in Geneva agreed that there were few if any signs
that the WHO secretariat was acting in a politically motivated way.
However, one delegate cautioned that in addition to a genuine motive in
wanting to strengthen the IHR, the WHO might also have been
"sniffing the political wind" and may have engaged in
"strategic positioning, based on past experience of being left
behind." (53) In other words, there have been indicators that the
WHO bureaucracy might have been receptive to notions of health security
in order to jump on the human security train, in an attempt not to be
disconnected from a shifting discourse in the UNDP and the UN system at
large. However, attempts of the WHO bureaucracy to side with proponents
of stronger securitization moves during the IHR revision could not be
ascertained.

The WHO's potential role in the fight against the deliberate
spread of disease also featured in the report of the UN
Secretary-General's High-Level Panel on Threats, Challenges and
Change, which the panel delivered in December 2004. (54) In Part 2 of
the report, "Collective Security and the Challenges of
Prevention," several paragraphs address the challenges of poverty
reduction, sustainable development, and the prevention of the spread of
infectious disease. Under the heading "New Initiatives," the
panel argues that "a new global initiative" is required to
"rebuild local and national public health systems throughout the
developing world." (55) In addition, WHA members are urged to
increase GOARN's "capacity to cope with potential disease
outbreaks." (56) Last, and more problematic, the panel recommends
that "in extreme cases of threat posed by a new emerging infectious
disease or intentional release of an infectious agent, there may be a
need for cooperation between WHO and the Security Council in
establishing effective quarantine measures." (57)

This notion of WHO-Security Council collaboration is reinforced
elsewhere in the report, where under the heading "Better Public
Health Defenses," the panel suggests that the "Security
Council should consult with the WHO Director General to establish the
necessary procedures for working together in the event of a suspicious
or overwhelming outbreak of infectious disease." (58) As Graham
Pearson has pointed out, with this last statement the panel is
"treading on dangerous ground," as it threatens to undermine
the WHO's "political neutrality and the widespread recognition
that its purpose is to provide assistance to its member states when they
are faced with outbreaks of disease." (59) However, this
far-reaching securitization move of the High-Level Panel was not
followed by the UN secretary-general, whose report mentioned the burden
of diseases like malaria, HIV/AIDS, and SARS only in a human security
context, not in relation to arms control verification activities.
Consequently, his recommendation is limited to a call on WHO member
states to agree on the revised IHR during the next WHA session. (60)

The Discourse on Disease Surveillance in the BWC Intersessional
Process

When the second part of the BWC Review Conference took place in
late 2002, BWC member states decided by consensus to hold annual
meetings from 2003 to 2005 that would address, among other things, (61)

enhancing international capabilities for responding to, investigating
and mitigating the effects of cases of alleged use of biological or
toxin weapons or suspicious outbreaks of disease [and] ...
strengthening and broadening national and international institutional
efforts and existing mechanisms for the surveillance, detection,
diagnosis and combating of infectious diseases affecting humans,
animals, and plants. (62)

This reduced program of work is a far cry from the comprehensive
approach of the Ad Hoc Group to reach agreement on a legally binding
protocol. (63) The discussion on the above-mentioned two agenda items in
2004 led to the inclusion of several substantive paragraphs in the
report of the meeting of states parties. (64) In it, BWC member states
recognize that

strengthening and broadening national and international surveillance,
detection, diagnosis and combating of infectious disease may support
the object and purpose of the Convention;... the primary
responsibility for surveillance, detection, diagnosis and combating of
infectious diseases rests with States Parties, while the WHO, FAO
[Food and Agriculture Organization] and OIE [World Organisation for
Animal Health] have global responsibilities, within their mandates, in
this regard. The respective structures, planning and activities of
States Parties and the WHO, FAO and OIE should be co-ordinated with
and complement one another. (Emphasis added) (65)

The acknowledgment of the existing mandates of WHO, FAO, and OIE stands in marked contrast to the High-Level Panel report, which, if
acted upon, would have led to a part of WHO's activities being
securitized. The wording in the report of BWC states parties likewise
displays greater consciousness in describing the scenarios in which WHO
assistance might be required: it refers to all cases of infectious
disease outbreak, not--like the panel report repeatedly--to
"suspicious" outbreaks. The latter approach implies already a
political judgment, which is anathema to the WHO's perception of
its role and mandate.

Implications for the Global Governance of Public Health and the BW
Prohibition Regime

This article set out to trace the securitization moves that have
been made in relation to international public health (IPH) in the two
discursive spaces most relevant to the provision of IPH and security
from the threat of biological weapons: the WHO and the meetings of BWC
states parties.

The securitizing speech acts that have been discussed in relation
to the WHO show that the organization has appeared in three different
roles or functions in attempts to securitize IPH: in the context of the
UN Secretary-General's High-Level Panel, the WHO appeared as the
object of securitization; during the IHR revision process, the WHO
served both as discursive space in which the securitization of IPH was
debated and as a securitizing actor in its own right. With respect to
the latter role, it is worth distinguishing between the promotion of the
notion of health security in human security terms and securitizing moves
that aim at a more traditional understanding of the concept. As the
previous discussion showed, what was supported by the WHO secretariat
was the former notion, not the latter. This position was motivated by
the preservation of its neutrality, in order to be able to continue the
broader roles foreseen in its mandate. Being implicated in verifying the
use of biological weapons or other aspects of BWC compliance would
compromise this neutrality. (66)

Noteworthy in this context is that all references to health
security have IPH as referent object--that is, as that which is to be
secured, not global public health. The role of states as central actors
in IPH has clearly been reaffirmed by the revised IHR: it is states, not
nonstate actors, that have to provide national focal points for the
implementation of IHR and also fulfill minimum standards in disease
surveillance and reporting. The WHO and NGOs, like the networks
contributing to the WHO's GOARN, have only a supporting role.

From this it follows that IPH has so far been only partially
securitized. This assessment is supported by a look at the resource
allocation for deliberate epidemics. This area of WHO's activities
is closest in substantive terms to BW control mechanisms. However, its
resources do not form part of the regular WHO budget, but are funded by
interested member states. This leads to an institutionalization on a
lower level that is more easily reversible in case the specific
interests of the states supporting the program on preventing deliberate
epidemics should shift. However, PDE represents yet another area in
WHO's portfolio in which intergovernmental mechanisms prevail. As
Fidler and others have pointed out, such an intergovernmental approach
to global public health problems is leading to suboptimal policy
outcomes when compared to an approach that strengthens global governance
mechanisms. In light of this, the continued preoccupation of parts of
WHO's secretariat with BW-related issues poses an obstacle to the
transition from international to global public health.

In sum, the attempts to securitize IPH in the context of the WHO
have led to a new mix of horizontal (i.e., intergovernmental) and
vertical strategies to provide public health. The state as actor in IPH
has been strengthened, while at the same time, the new health
regulations reach much deeper into states and affect their preparations
for public health emergencies of international concern. The definition
of such emergencies, however, appears to be much more oriented toward
the US Center for Disease Control's list of bioterrorism agents
than those disease-causing agents that have caused the most fatalities
over the last decade.

As for the implications of the attempted securitization of
international public health for the future of the BW prohibition regime,
a first question to consider is whether and to what extent the emergence
of the WHO as a new actor who "speaks security" in this area
will have an impact on the regime. On first glance, the setting up of
new organizational structures dealing with preparedness for deliberate
epidemics within the WHO secretariat might indicate the creation of a
competing actor to a potential future BWC secretariat. However, as the
analysis of WHO involvement in the BWC Ad Hoc Group deliberations and
the 2002 report on its PDE activities show, WHO has no intention of
taking on the role of verifying the use of BW or other aspects of
states' compliance with their obligations undertaken under the BWC.
Furthermore, at current levels of funding and manpower allocation,
WHO's PDE team would not have the capacity to perform such a
function in the first place. In sum, then, the WHO is not an actor that
should be expected to influence regime development in a major way.

As discussed in the section on the BWC intersessional process,
"enhancing international capabilities for responding to ...
suspicious outbreaks of disease" and "strengthening and
broadening ... the surveillance, detection, diagnosis and combating of
infectious diseases" had been selected as issue areas for
consideration by BWC states parties for the intersessional process
leading up to the 2006 BWC Review Conference. This heightened profile of
infectious disease surveillance could positively affect the
implementation of three core regime norms: the cooperation norm, the
assistance norm, and the internalization norm. However, such a positive
effect will depend on the overall approach taken by BWC state parties to
utilize the outcomes of the intersessional process. Should BWC state
parties, for example, decide to set up a small secretariat to assist
state parties in implementing more effectively the provisions of the BWC
in general and the recommendations that might flow from the 2003-2005
intersessional process more specifically, such a secretariat could
conceivably also take on a few functions that overlap with or utilize
the technical assistance WHO provides to its members. It might, for
example, tap into the information provided by GOARN and act as a
clearing house by assisting member states in identifying, from the
wealth of information provided by GOARN, suspicious outbreaks of
disease. This would also relieve the WHO of suspicions that it might be
misused as a Trojan horse to conduct BWC-related activities in public
health guise.

Should the community of BWC state parties not be able to reach
consensus during the 2006 Review Conference as to how to build on the
work of the intersessional process, the partially securitized IPH regime
will not be able to compensate for such a lack of political will.
Neither is it to be expected that implementation of the international
health regulations will detract from the attention BWC state parties
devote to their obligations under this convention. Thus, it will not
further weaken the already patchy BWC implementation record of a number
of state parties. If, however, the BWC state parties should not be able
to utilize the potential contribution of international public
health--within the boundaries of the mandate and scope of WHO's
activities--through the creation of new organizational structures for
the BWC, this would amount to nothing less than another lost opportunity
for the strengthening of the BW prohibition regime.

Notes

Alexander Kelle is a lecturer in international politics at
Queen's University, Belfast. A political scientist, he was
previously a Marie Curie research fellow at the Department of Peace
Studies, University of Bradford, and a science fellow at Stanford
University. Among his recent publications is Controlling Biochemical
Weapons: Adapting Multilateral Arms Control for the 21st Century (2006),
coauthored with Malcolm Dando and Kathryn Nixdorff.

1. The term is taken from Elin A. Gursky, Drafted to Fight Terror:
U.S. Public Health on the Front Lines of Biological Defense (Washington,
DC: ANSER, 2004).

2. See Alexander Kelle, Securitization of Public Health in the
United States of America: Implications for Public Health and Biological
Weapons Arms Control, Bradford Regime Review Paper No. 2, available at
www.brad.ac.uk/acad/sbtwc/regrev/Kelle_SecuritizationinUS.pdf.

6. Ole Waever, "The EU as a Sovereign Actor: Reflections from
a Pessimistic Constructivist on Post-sovereign Security Orders," in
Morten Kelstrup and Michael Williams, eds., International Relations
Theory and the Politics of European Integration: Power, Security and
Community (London: Routledge, 2000), p. 251.

9. Malcolm Dando, "The Impact of the Development of Modern
Biology and Medicine on the Evolution of Offensive Biological Warfare
Programs in the Twentieth Century," Defense Analysis 15, no. 1
(1999): 51.

11. The text of the BWC is available in numerous places; see, for
example, the website of the United Nations Office in Geneva,
www.unog.ch/bwc.

12. For a comprehensive discussion of the normative structure of
the BW regime, see Alexander Kelle, "Strengthening the
Effectiveness of the BTW Control Regime: Feasibility and Options,"
Contemporary Security Policy 24, no.2 (2003): 95-132.

13. Iris Hunger, Confidence Building Needs Transparency: A Summary
of Data Submitted Under the Bioweapon Convention's Confidence
Building Measures, 1987-2003, September 2005, available at
www.biological-arms-control.org/download/hunger_CBM.pdf.

33. W. Seth Carus, Bioterrorism and Biocrimes: The Illicit Use of
Biological Agents Since 1900 (Washington, DC: National Defense
University, February 2001), p. 11; Ron Purver, Chemical and Biological
Terrorism: The Threat According to the Open Literature (Ottawa: Canadian
Security Intelligence Service, June 1995).

37. See Milton Leitenberg, "The Experience of the Japanese Aum
Shinrikyo Group and Biological Agents," in Roberts, Hype or
Reality, pp. 159-170.

38. See WHO document at
www.who.int/gb/ebwha/pdf_files/WHA55/ea5520.pdf.

39. Ibid., p. 2.

40. Ibid., p. 3.

41. See www.who.int/gb/ebwha/pdf_files/WHA55/ewha5516.pdf, p. 2.

42. WHO, Preparedness for Deliberate Epidemics: To Support Member
States in Enhancing Their Preparedness and Response Programmes for the
Possible Deliberate Use of Biological Agents That Affect Health: Report
of Activities for the Biennium 2002-2003, Doc. WHO/CDS/CSR/LYO/2004.7
(Geneva: WHO, 2004), available at
www.who.int/csr/delibepidemics/preparedness/WHO_CDS_CSR_LYO_2004_7.pdf.

43. Ibid., p. 5.

44. Ibid., p. 6.

45. Unless otherwise noted, the following account of the discourse
on the revised IHR is based on a number of interviews with national
delegates involved in this process. Interviews were conducted in Geneva
during the week 5-9 December 2005.

46. See WHO Working Group on the Revision of the International
Health Regulations, International Health Regulations: Working Paper for
Regional Consultations, Doc. IGWG/IHR/Workingpaper/12.2003 (Geneva: WHO,
12 January 2004).

47. Ibid., pp. 2-3.

48. Interviews with delegates in Geneva, 7 and 8 December 2005.

49. WHO, Decision Instrument for the Assessment and Notification of
Events That May Constitute a Public Health Emergency of International
Concern: Report of the Ad Hoc Expert Group on Annex 2, Doc.
A/IHR/IGWG/2/INF.DOC./4 (Geneva: WHO, 22 February 2005), p. 7.

52. Ibid., p. 9. See also Statement for the Record by the
Government of the United States of America Concerning the World Health
Organizations Revised International Health Regulations (Geneva: US
Mission to the United Nations in Geneva, 23 May 2005), available at
www.usmission.ch/Press2005/0523IHRs.htm.

62. Final document of the Fifth BWC Review Conference, Doc.
BWC/CONF.V/17, p. 3, available at
http://disarmament2.un.org/wmd/bwc/pdf/bwccnfv17.PDF.

63. See Kelle, "Strengthening the Effectiveness," note
11.

64. United Nations, Report of the Meeting of States Parties, Doc.
BWC/MSP/2004-3 (Geneva: United Nations, 14 December 2004), available at
www.opbw.org/new_process/msp2004/BWC_MSP_2004_3_E.pdf.

65. Ibid., p. 4.

66. Although intended in no way as a comprehensive answer, this
finding also speaks to the issue recently raised by McInnes and Lee
concerning the "lack of conceptual clarity over what WHO and others
term 'global health security.'" Collin McInnes and Kelley
Lee, "Health, Security and Foreign Policy," in Review of
International Studies 32, no. 1 (2006): 23.

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